Subcutaneous Opioids: Under the Skin Irritation or New Standard of Care?

Abstract

Background: Opioids are widely used for pain management in hospitalized adults and can be administered through various routes. While oral (PO) and intravenous (IV) routes remain most common, the subcutaneous (SUB-Q) route is underutilized despite historical safety and supporting literature.

Objective: This quality improvement study implemented a revised standard of practice (SOP) for opioid administration, promoting the PO route when feasible and SUB-Q as the preferred parenteral route. IV remained available when clinically appropriate.

Methods: This pilot study was conducted on a 24-bed adult general medicine unit at a large community teaching hospital. Extensive interdisciplinary education was provided prior to SOP implementation. Primary outcomes evaluated IV and SUB-Q opioid administrations. Secondary outcomes analyzed total opioid administrations (all routes), mean oral morphine equivalents (OMEs), and mean patient-reported pain scores (0-10 scale). All outcomes were measured per patient day (PPD) during the first five days of admission.

Results: IV opioid administration decreased by 33% while overall opioid consumption (OMEs) was modestly reduced. Statistically significant reductions in average pain scores were observed postintervention on days one and five.

Conclusions: Implementation of a new opioid SOP was associated with reduced IV opioid use while maintaining effective pain control across both groups.